Thursday, June 26, 2008

THE CUSTOMER IS (OR SHOULD BE) ALWAYS RIGHT

– BUT HOW ABOUT PATIENTS? A just-published report by Gruber and colleagues (Drug Alc Dep 94:199-206,2008) presents findings of a clinical trial carried out more than a decade earlier. One interesting facet is the diametrically opposite views of authors and “subjects” regarding detoxification. The former dismiss detoxification without qualification as “not an effective treatment.” The subjects, on the other hand, had “voted with their feet;” all were recruited from a voluntary, ambulatory, 21-day detoxification program. “Complete informed consent procedures” were applied, but one must wonder if the information provided (by the researchers and by their clinical colleagues) included the judgment that detoxification was deemed ineffective. At any rate, the seeming dichotomy in perspective might be explained as reflecting the common view of many professionals that achieving and maintaining long-term abstinence is a sine qua non of therapeutic success, while in this study “… only a third [of the detoxification patients] stated they wanted to quit heroin completely; most were hoping to use less or use more safely.” Measured by this more modest, but nonetheless meaningful, objective, detoxification would seem to be an eminently reasonable and promising option.